Utilization Management Nurse 2 - North Central Region Remote - MN IL WI SD ND

Profile

Description

The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

Required Qualifications


Licensed Registered Nurse (RN) in Illinois with no disciplinary action is required
3-5 years of Medical Surgical, Critical Care, ER, Heart or Lung Nursing experience
Prior clinical experience preferably in an acute care clinical setting
Comprehensive knowledge of Microsoft Word, Outlook and Excel
Ability to work independently under general instructions and with a team
Must be passionate about contributing to an organization focused on continuously improving consumer experiences


Preferred Qualifications


Previous experience in utilization management
Education: BSN or Bachelor's degree in a related field
Health Plan experience
Previous Medicare/Medicaid Experience a plus
Call center or triage experience
Bilingual is a plus


Work-At-Home Requirements


WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense
A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required
Satellite and Wireless Internet service is NOT allowed for this role
A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information


Additional Information


Hours for this role are: Monday-Friday 8am-4:30pm or 8:30am-5pm CST
This role will require two 4 hour shifts per year to be worked during a holiday weekend. One 4 hour shift during the summer and one 4 hour shift during the winter


Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

Scheduled Weekly Hours

40

Company info

Sign Up Now - NursingCrossing.com